Tuesday, February 17, 2009

Docs ignoring safety guidelines for second generation antipsychotics

We’re getting better and better at searching and appraising evidence. In contrast we’ve made little or no progress in that final and most important step of EBM: putting the evidence into practice. We know the rate of uptake is poor. Figures of 30%-50% are often tossed around. But for guideline recommended metabolic monitoring of patients given second generation antipsychotics it’s almost zilch:

A total of 5,787 preguideline patients and 17,832 postguideline patients were identified. Baseline lipid testing rates were 8.4% for the preguideline cohort and 10.5% for the postguideline cohort, and the 12-week testing rates were 6.8% and 9.0%, respectively. Baseline glucose testing rates were 17.3% for the preguideline cohort and 21.8% for the postguideline cohort, and the 12-week testing rates were 14.1 and 17.9%, respectively.

Metabolic complications of these drugs occur gradually and are heralded by weight gain and laboratory changes. Adherence to the monitoring guidelines would make them much safer drugs.

As I’ve said many times drug safety is more about how doctors use drugs than it is about drugs’ inherent properties.